Thank you for your inquiry regarding CMS871v5, Hospital Harm - Severe Hyperglycemia. For this measure, the inpatient hospitalization includes time in the emergency department (ED) and observation when the transition between these encounters to the inpatient encounter is one hour or less, regardless of how much time the patient spends in the ED encounter and/or observation status. If there is more than one hour between the discharge from the ED or observation encounter and the start of the inpatient encounter, then the inpatient hospitalization begins at the start of the inpatient encounter. If there is one hour or less between the discharge from the ED or observation encounter and admission to the inpatient encounter, the inpatient hospitalization period begins at the start of the ED or observation encounter. If the inpatient hospitalization period begins at the start of the ED encounter, then ED encounter start time is used to anchor the seven-hour window for the first part of the exclusion criteria. See below in the attachments section for a table that illustrates an example of an inpatient hospitalization that would meet the measure's denominator exclusion criteria.